INSANE hackers call me saying they are from microsoft and try to scam me into giving them money and computer access– what do you do? keep them going by asking about klingon cloaking devices and porn hackers and the FBI–SCAM THE SCAMMERS!

This is the edited version of all three calls together ….its gets insane klingon transformer at 1:50 and then porntastic my son is a porn hacker at 4:45– my kids and wife are hysterical in the background and he called back 4 times

“Jack” the scammer kept calling our house claiming to be from “Microsoft”. He said our home computer had been “hacked by Mexican hackers” and he needed to access it immediately to correct the intrusion. He called three times as we were cooking dinner– a tthat time my wife came and told me and I figured time to turn the tables.

When jack called back I started agreeing with everything he said… but started asking him questions

How come his Microsoft ID is missing digits?

How could he bypass my VPN quad core routing Klingon Cloaking router that diverts my connections through the Caymen islands?

What do i do with all the gears and wires?

We got disconnected and he called back—- 3 times. So each time I escalated the counter scam

I started screaming about porn on my computer and getting arrested if he didn’t help!!

Finally I get escalated to his supervisor scammer and connect them to my friend in the FBI who is on the line to trace the call….

]]>http://docinthemachine.com/scamming-the-scammers/feed/0http://docinthemachine.com/scamming-the-scammers/New Online Cyber Journal Club Platform Launchedhttp://feedproxy.google.com/~r/Docinthemachine/~3/xNbjtWDHPKI/
http://docinthemachine.com/online-journal-club-platform-launced/#commentsTue, 02 Apr 2013 13:44:57 +0000info@docinthemachine.com (Steven F Palter, MD)http://docinthemachine.com/?p=793<p>I am thrilled to share that we have launched the world&#8217;s first journal club of tomorrow bringing a 200 year-old mainstay of medical education into the 21st century....</p>
<p>The post <a rel="nofollow" href="http://docinthemachine.com/online-journal-club-platform-launced/">New Online Cyber Journal Club Platform Launched</a> appeared first on <a rel="nofollow" href="http://docinthemachine.com">docinthemachine</a>.</p>I am thrilled to share that we have launched the world’s first journal club of tomorrow bringing a 200 year-old mainstay of medical education into the 21st century.

For the first time, using the latest in video technology, the American Society for Reproductive Medicine (ASRM) participated in a live online transcontinental Journal Club for practicing physicians, academics and students. The Journal Club Live™ platform featured a ten-way discussion of fellows and professors from the USA, Europe, and India well as the article’s author. Free open video group chat is a mainstay of gamers worldwide – now this technology transforms medical education.

Every physician and scientist used journal clubs during their training to learn the latest breakthroughs in their field and to lean how to critically read research. Unfortunately once they finish their training this beloved tool is lost. Even worse, skyrocketing responsibilities and workloads are cannibalizing the time previously reserved for journal clubs in even the best academic institutions.

Since the 1800’s Journal Clubs, or closed research critique sessions have been a mainstay of medical research and education. With the launch of the Online Cyber Journal Club™ platform, the conversation among academics, patients and students can be shared worldwide and disseminated in real time.

The reader of the journal can now become part of an ongoing, dynamic, live discussion that enhances the value of the original research. With this effort, we have bridged the gap separating the digital and traditional medical literature and embraced the global technological future of medicine. This integration will lead to exciting new directions in research.

The sessions are archived and accessible to anyone anywhere. No fees, no registration, no membership , no subscriptions, and no firewalls. The first international one is at http://fertstertforum.com/journalclubmarch2013/ and the first test proof of concept is at http://fertstertforum.com/journalclubfeb2013/ These were fertility-based discussions on controversial subjects related to the best medications to use to prepare the uterus for pregnancy and the best timing of embryo development – however the platform works equally well across all specialties and disciplines.

An online real-time live journal club has never taken place before. We are very excited about this new digital expansion of what has been a mainstay of medical research and education, now taken into the 21st century as a powerful new teaching tool for physicians and patients.

The entire event was live-streamed on YouTube using technology from Google with custom modifications from the Journal Club Live™ platform and was open to comments and questions and free participation from anyone around the world.

I knew we were onto a great idea when I performed our initial needs assessment. Even informally discussing the idea among fellows and professors led to an excitement I had not seen for any other on-line educational venture. They were clamoring to have the first one and fighting to join in. I followed this with a formal survey of the trainees and program directors in our specialty and found 100% support for the concept. A majority went so far as to say they would even make participation manditory for those in their department.

The Three classical goals of Journal Clubs:

to keep up with the cutting new developments in your field

to learn to classical references from the past

to learn how to critically read new research and decide how to critique them

Today’s New barriers to medical education and journal clubs:

There is an exponential increase in the number of new high quality research publications but less time to read them

There are more journals than ever but less funds to subscribe to them

The departmental journal clubs of the past are largely gone – victims of shrinking budgets and time

Physicians have less time and money to attend local or national medical meetings

New Opportunities of the Journal Club Live™ Platform- the Online Cyber Journal Club™ Platform:

all of the opportunities of traditional journal clubs

24/7 365 access to video archives of the discussions

an international community of participants building collaboration

direct access to the leading experts in the field

ability to be mentored by experts from around the world

collaborative discussions between physicians patients and industry

for the first time ever participation by the journal article’s author

Not unexpectedly the top benefits of participation as ranked by trainees from the needs assessment survey were:

keep up with the latest research

learn the classical references

interact regularly and network with fellows from other programs

have an opportunity to personally interact with leading professors from other departments

learn how to critique research studies

develop collaborations for new projects

What was so rewarding was to see how much all the participants enjoyed coming together with this new platform. “This was a terrific way to share results and to discuss an article. I learned a lot more by actually being able to interact with people from different places and the author and moderators than I would have just sitting in a cold room even though my colleagues are wonderful,” said Dr Kurt Barnhart, William Shippen, Jr. Professor of Obstetrics and Gynecology at the University of Pennsylvania, Associate Editor of Fertility and Sterility, and a participant in the event.

Happily , the same reaction came from the author who had the never to sit in the hot seat and defend her research. The author of the study discussed participates in the event as well. “It was great. Sometimes when you have your article critiqued…you learn something about your research that you had not thought about before,” said Dr Elizabeth Ginsberg, Medical Director, Assisted Reproductive Technologies, Brigham and Women’s Hospital, and Associate Professor, Harvard Medical School.

Fertility and Sterility, the flagship journal of the American Society for Reproductive Medicine (ASRM) and its publisher Elsevier have created, and for the first time ever published, a new multimedia article format that integrates video and traditional print research.

This project has been my labor of love for the past year and I am so excited to share the details here. It began with my frustration at seeing medical research shoehorned into an an antiquated print system that precluded any leverage of the power of modern digital research and communication.

Online video and traditional print were previously two separate and unrelated worlds in scientific research. I was astounded when i saw online journals that described how traditional print research couldn’t allow multimedia content. It was obvious that we needed to find a mechanism to radically change medical research from within the system rather than try to build something new and reject a system used by all of scientific research.

The new mechanism allows videos to be cited the same way as a written article in a traditional print medical journal and seamlessly unifies online multimedia content and print journals. Researchers can watch footage of innovations and techniques and learn previously inaccessible information in new non-written formats while still being able to find this information through traditional medical print sources.

In the press release announcing the new initiative I was quoted:

“For the last 200 years, medical publishing remained unchanged. Our solution accommodates non-print work through fully integrated multimedia, opens up a whole new form of learning, and allows readers to become part of an ongoing interactive discussion,” says Dr. Steven Palter, the Video and New Media Editor of Fertility and Sterility. Dr. Palter, who developed the concept and spearheaded the project, says, “With this effort, we have bridged the gap separating the digital and traditional medical literature. This integration will lead to exciting new directions in research.”

The new media initiative is unique in several ways. It allows an article to exist simultaneously online and in the traditional medical journal and it enables videos to be citable publications for all traditional journals. Fertility and Sterility embeds an open access link in the article that appears both in PubMed and the Journal’s electronic tables of contents, and also in the print journal. QR codes associated with each article seamlessly bring readers from print journal to online video. Authors can create review articles, experimental techniques, anatomic overviews, case reports, and more. Videos, which are peer reviewed as part of the mainstream submission process are served open source through Google’s YouTube.

Craig Niederberger, MD, Co-Editor-in-Chief of Fertility and Sterility said, “We are committed to using modern communication methods, from online video to social media to enhance Fertility and Sterility. Medical journals are about conveying new information and new discoveries to others in the field. We simply cannot rely on print alone to do that anymore.”

Antonio Pellicer, MD, Co- Editor-in Chief of the journal, said, “Medicine has always been an international pursuit. Now with online distribution of multimedia articles the sharing of knowledge can occur even faster, indeed simultaneously around the globe, thus improving patient care more quickly and without regard to geography.”

Other digital on-line only journals have provided multimedia in the past and helped push the envelope. For example The Journal of Visualized Experiments (JoVE) is publishing experimental techniques in the biological sciences in video format.â€ However this and other similar online only journals were a reaction to the limitations of the traditional print infrastructure– but remained separate and distinct from tradition mainstream medical research journals. As such this model was not embraced by the mainstream. Online only content is not integrated with traditional print journals where most research is published and is an island unto itself. Traditional print journals could not use this system and the distinction remained a barrier that prevented this model from being used by other journals. For our project I worked to find a solution whereby print and online were one integrated reciprocal system.

My vision for a digital “article 2.0″ and our initiative at F&S includes a key component of freely accessible interactivity available at www.fertstertforum.com. In addition to the multimedia video article every article published in Fertility & Sterility will have an open discussion forum freely accessible to anyone… .subscribers, non-subscribers, physicians, researchers, industry and patients alike. We stood fast behind the belief that free exchange of ideas will benefit all of medical research and we are willing to take the risks that come with opening the discussions up publicly. We will also allow authors to submit video introductions to their articles and readers to submit video rebuttals- again all accessible through the journal or through YouTube.

With this innovation, ASRM and Elsevier have embraced the digital revolution that has rapidly transformed traditional publishing. Just as the Amazon Kindle brought epublishing to the masses, the new video article initiative of Fertility and Sterility bridges the gap between online multimedia and traditional medical research publishing.

This is part of a larger movement in publishing. Up until about 2009, the epub world and the NY mainstream publishing establishment were two separate worlds, divided by technology. In the realm of fiction, books have been published electronically since the 1990s, but were distinct and separate from traditional print publishing. Fiction that was a bestseller in that ebook world was largely unknown in the realm of mainstream, NY publishing. All that changed with the advent of the Kindle.

Amazon brought the technology of publishing books electronically to the mainstream marketplace — people who had never heard of e-publishing could now download electronic books using an application, the Kindle, designed to make electronic books even easier to buy than print books. They revolutionized publishing not by inventing a new kind of publishing (e-publishing had existed for nearly 20 years before the Kindle came out) but by bringing the digital revolution to a mainstream market. They universalized what had been a niche technology by bridging the gap between old school print publishing and the new digital ebooks.

By 2010, Amazon reported that its ebook sales outstripped its sales of print books. And now, digital publishing is fueling the profits of mainstream NY publishers. There is no more epublishing world and print publishing world – the two are integrated. It has become one big marketplace, and it is revolutionizing publishing around the world, part of the larger Digital Age.

Our editors view Fertility and Sterility as much more than a print entity and are embracing new and innovative ways of delivering research and engaging our readers. It’s a very exciting time for the Journal,â€ notes Elsevier Publisher Andrea Boccelli.

Embracing new technologies that support rapid transfer of critical information, add value to that information, and drive scientific innovation is a cornerstone of Elsevier’s publishing strategy, adds Christine Rullo, Vice President, Health and Medical Sciences, STM Journals. In keeping with this mission, we are extremely proud to publish Fertility and Sterility on behalf of ASRM and to have collaborated with them to realize this innovative multimedia program. This is an important step in the continuing evolution of the scientific article.

The first article “Single port laparoscopy” is authored by L. Carvalha et al from the Cleveland Clinic, and appears in the May 2012 issue of Fertility and Sterility and shows a new surgical principle. The abstract both on-line and in the print publication leads to an online video showing the technique. http://fertstertforum.com/2012974caravalho The article is currently indexed in PubMed at http://www.ncbi.nlm.nih.gov/pubmed/22542145

]]>http://docinthemachine.com/medical-publishing-revolution/feed/0http://docinthemachine.com/medical-publishing-revolution/Welcome to the New Multimedia Fertility & Sterilityhttp://feedproxy.google.com/~r/Docinthemachine/~3/68hJdTpHK64/
http://docinthemachine.com/multimedia_fertility_sterility/#commentsTue, 19 Jun 2012 03:00:12 +0000info@docinthemachine.com (Steven F Palter, MD)http://docinthemachine.com/?p=717<p>Medical research teaching has remained essentially unchanged for over 200 yearsâ€¦.until now. Dr. Steven Palter has been named the first ever Editor for video and New Media for...</p>
<p>The post <a rel="nofollow" href="http://docinthemachine.com/multimedia_fertility_sterility/">Welcome to the New Multimedia Fertility &#038; Sterility</a> appeared first on <a rel="nofollow" href="http://docinthemachine.com">docinthemachine</a>.</p>Medical research teaching has remained essentially unchanged for over 200 yearsâ€¦.until now. Dr. Steven Palter has been named the first ever Editor for video and New Media for the worldâ€™s leading fertility journal Fertility & Sterility. F&S is the official publication of the American Society for Reproductive Medicine (ASRM).

I am excited to lead the lead the digital initiative of the journal into the 21st century.Â Â In this video I discuss with Co-editors in Chief Craig Niederber and Antonio Pellicer a series of initiatives to transform how fertility and medical research in general is published shared and taught. See the exciting new developments in multimedia interactivity in Fertility & Sterility and how they can help you keep up with the explosive volume of new developments.

Together we discuss medical research, online interactivity, the guttenberg revolution, and what a Tom Petty concert, a kindle and an iPOD have to do with the future of medicine.

]]>http://docinthemachine.com/new_media_podcast_fertiitysterility/feed/0http://docinthemachine.com/new_media_podcast_fertiitysterility/Another Day Another EMR Data Breech: Shades of Things to Comehttp://feedproxy.google.com/~r/Docinthemachine/~3/4VyMyuJBs3g/
http://docinthemachine.com/databreech/#commentsThu, 30 Sep 2010 02:26:05 +0000info@docinthemachine.com (Steven F Palter, MD)http://docinthemachine.com/?p=653<p>I have been doing quite a lot of work lately on setting up redundant network attached servers and cloud storage systems for what is now about 2TB of...</p>
<p>The post <a rel="nofollow" href="http://docinthemachine.com/databreech/">Another Day Another EMR Data Breech: Shades of Things to Come</a> appeared first on <a rel="nofollow" href="http://docinthemachine.com">docinthemachine</a>.</p>

I have been doing quite a lot of work lately on setting up redundant network attached servers and cloud storage systems for what is now about 2TB of data.Â It has been increasingly clear to me that none of the systems I see would be adequate for the panacea that everyone thinks EMR’s are.Â I predict we are in for a huge wave of data security breeches at best and total data losses at worst.Â many docs using EMR’s I’ve seen have woefully inadequate data security and backup plans.

Just reported: another day, another privacy breach. New York-Presbyterian Hospital and Columbia University Medical Center “inadvertently” posted the personal information of about 6,800 patients–including names, clinical data and 10 social security numbers–online, reports the New York Times. While the breach was discovered in July (after a patient’s relative saw the information online), the hospital and medical center didn’t announce the problem untilÂ yesterday because of an ongoing investigation.

The personal information was accidentally placed on a server, but has since been removed, the hospital said in a statement.

During the breach, exposed data such as names, ages, surgical status, temperature and pulse became accessible to search engines, Myrna Manners, a NewYork-Presbyterian Hospital spokeswoman told the Times. Patient diagnoses were not disclosed, she noted.

]]>http://docinthemachine.com/databreech/feed/0http://docinthemachine.com/databreech/Don’t Let You Doctor Order These 10 Useless Lab Test Docs Won’t Stop Gettinghttp://feedproxy.google.com/~r/Docinthemachine/~3/CPhNXsrNxSI/
http://docinthemachine.com/10badtests/#commentsThu, 30 Sep 2010 02:16:12 +0000info@docinthemachine.com (Steven F Palter, MD)http://docinthemachine.com/?p=652<p>New Study in the current issue of the American Journal of Managed Care, found that many doctors continue to order antiquated tests of minimal to no usefulness. The...</p>
<p>The post <a rel="nofollow" href="http://docinthemachine.com/10badtests/">Don&#8217;t Let You Doctor Order These 10 Useless Lab Test Docs Won&#8217;t Stop Getting</a> appeared first on <a rel="nofollow" href="http://docinthemachine.com">docinthemachine</a>.</p>New Study in the current issue of the American Journal of Managed Care, found that many doctors continue to order antiquated tests of minimal to no usefulness.

The 10 tests (dating back to the 1960′s) are:

creatine kinase-MB

myoglobin

serum folate

blood cell folate

amylase

lecithin/sphingomyelin ratio testing

qualitative serum human chorionic gonadotropin

prostatic acid phosphatase

bleeding time

ESR

I must say this is an example where the old taboo idea of “economic migration” would end it overnight.Â That is — have managed care simply make these tests not reimbursable (ie if you order the test the lab won’t be paid for it) and the use of these tests will end overnight.Â HOWEVER– just the opposite happens. Newly introduced tests of clear benefit languish for months or years (ie MIF/AMH in fertility) being refused by managed care and patients forced to pay out of pocked for them. Â Interestingly the old bad tests are relatively cheap and the new ones routinely more expensive.

According to the study, “given the current economic climate for medical practices, it is the responsibility of clinical laboratory directors â€¦ to review their test menu and â€¦ remove tests that do not provide clinical value to a particular medical practice, whether such testing is conducted in-house or sent to a reference laboratory.”

In fact, a recent paper in the American Journal of Obstetrics & Gynecology found that many US labs are using outdated genital herpes tests that often yield false-positive results.

“Commercially available herpes simplex virus antibody assays that were not glycoprotein-G based demonstrated high false-positive rates (14 percent-88 percent) for herpes simplex virus type-2 antibodies in sera that were positive for herpes simplex virus type-1 antibodies but negative for herpes simplex virus type-2 antibodies,” according to the paper. “Herpes simplex virus serologic testing should be performed with only glycoprotein-Gâ€“based tests.”

]]>http://docinthemachine.com/10badtests/feed/0http://docinthemachine.com/10badtests/The Next Revolution in Medical Devices: Self-Design and Prototypinghttp://feedproxy.google.com/~r/Docinthemachine/~3/-MwW0DPVl1c/
http://docinthemachine.com/self-design/#commentsMon, 27 Sep 2010 04:19:51 +0000info@docinthemachine.com (Steven F Palter, MD)http://docinthemachine.com/?p=640<p>have just returned from the Maker Faire and have seen the future of medical device innovation, invention, and design&#8211; Self-design and rapid home prototyping.Â For those unfamiliar with...</p>
<p>The post <a rel="nofollow" href="http://docinthemachine.com/self-design/">The Next Revolution in Medical Devices: Self-Design and Prototyping</a> appeared first on <a rel="nofollow" href="http://docinthemachine.com">docinthemachine</a>.</p>have just returned from the Maker Faire and have seen the future of medical device innovation, invention, and design– Self-design and rapid home prototyping.Â For those unfamiliar with the jargon basically technology now exists that can allow the creation of a working prototype of a device from idea to an actual working hand-held version in a physician-inventor’s own home.Â This has the potential to democratize the process and eliminate previous massive cost and technological barriers that kept the process inaccessible except to large industry or those with substantial capital resources.

One person I spoke with was calling this the Next Industrial Revolution.Â To me this is clearly the inevitable technological evolution of design and device innovation following in the exact path blazed by desktop publishing, digital video and computer based editing for movie creation to name just two examples.Â –And once again it is fueled by the exponential progress in computer power –here married to a fanatical base of innovators driving the creation of the raw tools that will be the assembly line of the future.

What is Maker Faire? Maker Fair just had its first NY exhibit and is an offshoot of Make magazine.Â MAKE brings the do-it-yourself mindset to all the technology in your life. Think of it as technology-hackers.Â Its like wood-shop for the 21st century hacker who is building his own radio controlled spy drone or augmented reality device instead of oven mitts and hotplate coasters.Â AS they write “this is a magazine that celebrates your right to tweak, hack, and bend any technology to your own will. For example, in our first volume, we show you how to get involved in Kite Aerial Photography, how to make a cheap but effective video camera stabilizer, and how to build a device that reads the hidden information stored on the magnetic stripes on all your credit cards.”

Homelab laser engraver/cutter.Â can carve any substance with laser power and precision.Â cuts out 3D models too.

But that’s just the beginning.Â The sophistication of the home creation kits is mind-blowing.

This is a beagleboard.Â It contains all the power of an entire computer.Â It was running what looked like a normal desktop with a video capture and object recognition on a version of linux.Â It costs less than $500 and can be the basis for home-made computer intelligent devices.Â All open source as well.

At the Faire take thousands of people with this mindset, demos, kits, and lessons to “celebrate arts, crafts, engineering, science projects and the Do-It-Yourself (DIY) mindset.”Â And as usual for my tech crossovers— add one doctor to the group.

What’s The Medical Significance? As usual I search out emerging technologies not yet used in medicine that have the potential to right now change how we do things.Â What’s struck me with all I saw was the common theme that anything that was a high tech machine now today can be imagined, designed, researched, 3D modeled, and turned into working prototype all in a home workshop on an inventor’s budget.Â What’s more this now applies to the physical aspects (ie plastic casing and movable parts) and to the electronics being them embedded operating systems or any myriad of sensors.Â The theme of the day was that you yourself can see these projects through to this stage and there is a thriving community and ground-swell of momentum to build a grass roots infrastructure to help.

Examples of 3D Prototyping/Desktop Manufacturing:

The left image is a makerbot — you build this machine and then it produces 3d models out of plastic from 3D images on you computer.Â You can anything from an action figure to a device handle to well– the middle images was made on a higher end system like that shown on the right.Â here the machine first modeled the bones then applied a tissue layer over it.Â The system right now can take any 3D dataset from an ultrasound MRI or CT scan and reconstruct 3D tissue or organ models.Â I’ll follow up in a later post how scientists are using such technologies to literally build artificial organs in the lab– they build the structure then seed it with living cells that create the organ.Â The maker bot replaces a $100,000 fabricator from a decade ago and costs under $1500– and its all open source.

Could You Cure a Disease With a Device Invention?Â Does Your Child Think He or She Could?Â You’d be Surprised?Â The New Inventor’s Mindset for the 21st Century. You probably grew up thinking devices of all sorts and especially electronics were otherworldly gizmos of incomprehensible complexity of design.Â The workings of a TV, video camera, or electronic medical diagnostic device where the stuff that onlyÂ biomedical engineer with a pocket protector and a degree from MIT could have created.Â Your kids think otherwise.Â They are comfortable with technology and with programming computers when presented with understandable languages.Â They can make a webpage.Â They can edit video and retouch photos.Â They have a myspace page.Â They may tinker with remote control toys.Â Many of them with some practice can create 3D computer graphics.Â Just recently A Russian amateur filmmaker called Alexander Semenov produced this 2.5 minute bootleg Transformers short with a couple of sub-$1,000 cameras, two hours’ of footage and a month in the home desktop editing suite that many think rivals the effects of a million dollar Hollywood blockbuster.

Understand that the next generation of design and creation tools will use these same sorts of visual programming language and are just as accessible. I walked through the exhibits with a 6 and 9 year old. By the end of the day the 6 year old had soldered an LED lit circuit board to make an electronic toy (parts cost $1), both had piloted radio controlled robots complete with sensors, and had begun to design autonomous robotic creatures– and they had never done this before.Â I was recently asked to give a talk to a group of 4th graders working on the Lego First competition.Â This is a robotics competition for kids to build working devices.Â There are more than 10,000 teams competing this year.Â This year’s theme is biomedical research.Â They kids were instructed that they have the tools to invent a device that could solve a medical problem.Â They don’t believe only MIT engineers solve problems.Â They expect to.Â Remember who invented youtube and facebook.

home kit for sensor based mobile search and rescue bot.Â The same sophistication as a military robot and the same technology as in implantable body rovers being developed.

robotic arm prototype- could model prosthetics

home made kit for scanning tunneling microscope for research uses.Â A scanning tunneling microscope (STM) is a powerful instrument for imaging surfaces at the atomic level. Its development in 1981 earned its inventors the Nobel Prize in Physics in 1986. For an STM, good resolution is considered to be 0.1Â nm lateral resolution and 0.01Â nm depth resolution.With this resolution, individual atoms within materials are routinely imaged and manipulated.Â This is now a do-it-yourself kits for under $200 all open source design and technology

]]>http://docinthemachine.com/self-design/feed/0no have just returned from the Maker Faire and have seen the future of medical device innovation, invention, and design&#8211; Self-design and rapid home prototyping.Â For those unfamiliar with... The post The Next Revolution in Medical Devices: Self-DesigSteven F Palter, MD have just returned from the Maker Faire and have seen the future of medical device innovation, invention, and design&#8211; Self-design and rapid home prototyping.Â For those unfamiliar with... The post The Next Revolution in Medical Devices: Self-Design and Prototyping appeared first on docinthemachine. medicine,technology,fertility,reproductive,endocrinology,minimally,invasive,surgery,medical,technologyhttp://docinthemachine.com/self-design/http://vimeo.com/moogaloop.swf?clip_id=14852606&amp;server=vimeo.com&amp;show_title=0&amp;show_byline=0&amp;show_portrait=0&amp;color=00ADEF&amp;fullscreen=1&amp;autoplay=0&amp;loop=0How Much is Your Baby’s Life Worth? Experts Use Economics to Decide on Genetic Screeninghttp://feedproxy.google.com/~r/Docinthemachine/~3/VWJsHJ-bTjs/
http://docinthemachine.com/economicgenetics/#commentsMon, 15 Mar 2010 23:31:07 +0000info@docinthemachine.com (Steven F Palter, MD)http://docinthemachine.com/?p=639<p>Screening all pregnant women for a rare but fatal genetic disease is too expensive, researchers say in a new report that adds to a recent controversy about whether...</p>
<p>The post <a rel="nofollow" href="http://docinthemachine.com/economicgenetics/">How Much is Your Baby&#8217;s Life Worth? Experts Use Economics to Decide on Genetic Screening</a> appeared first on <a rel="nofollow" href="http://docinthemachine.com">docinthemachine</a>.</p>Screening all pregnant women for a rare but fatal genetic disease is too expensive, researchers say in a new report that adds to a recent controversy about whether genetic tests are worth the cost.Â Â The research is reported in the new issue of AMJOG and reported in summary here.

While scientists can already screen for SMA, allowing parents to seek an abortion or decide against having children, doctors are split on whether or not to recommend routine screening due to cost concerns.

The new study analysis comes to $5 million for each case of SMA avoided by prenatal screening- and decides its too expensive.

“We found it to be too expensive,” said Dr. Sarah Little of Massachusetts General Hospital, who worked on the study. She added that the value for money was a tiny fraction of what is generally considered acceptable by health economists.

While a genetic test for SMA costs just under $500, more than 12,500 women would have to be screened to prevent one case of SMA, which affects only about 1 in 10,000 newborns.The results bolster guidelines from the American College of Obstetricians and Gynecologists, which recommends that only parents with a family history of SMA get screened.

However, another professional association, the American College of Medical Genetics, was not impressed with the study, which was published in the American Journal of Obstetrics and Gynecology.

“They came to the wrong conclusion because they used the wrong tool to do the evaluation,” said Michael Watson, executive director of the American College of Medical Genetics, which recommends universal screening for SMA.The team used the standard method of calculating cost-effectiveness, which naturally favors screening for diseases such as cystic fibrosis in which patients live long lives and require expensive treatment.

When patients die young, in contrast, they don’t incur a lot of expenses, and so the dollar value of preventing such diseases is smaller.Â “It’s just not a practical approach,” said Watson, adding that “we could save a ton of money in the US if everybody died.”Â I have often pointed this out to those who criticize fertility care as being too expensive for the health care system.Â Cancer care andÂ intensive care units are very expensive.Â If we only use cost effectiveness analysis then we would only offer preventive health, nutrition, smoking cessation, and vaccinations.Â Much more cost effective then treating elderly sick people!

As a fertility specialist I deal with the SMA genetic screening test on a daily basis.Â I advise all infertile couples of the existence of the test and the risks of being a carrier and having an affected child.Â As is the case with cystic fibrosis and fragile X most couples do want to be screened once they know the test exists.Â For those who test positive in both male and female some have chosen to have PGD where I test the embryo during IVF to see if it is affected and only replace those that are not.Â I have had couples use this test to successfully have a healthy child unaffected by SMA.Â Just recently I saw couples who came specifically for PGD having lost more than one child who died from SMA– and they were unaware that testing existed before.

This reminds of when a west coast state (think it was washington) used a cost effectiveness analysis to decide which medical treatments their public health insurance would cover.Â Treatments were ranked and they went down the list until the budget ran out.Â This system was very poorly received.

I hate to rock the boat but as advances in genetic diagnosis are exploding this problem is going to go through the roof.Â I can now test for far more genetic diseases than tests existed for 10 years ago.Â Using DNA chip technology I can now screen for over 200 diseases.Â Is this cost effective?Â Would you want to have it done?Â When I thought about having children I wanted to be tested for everything possible!Â Just last week I had a Yale student on a research elective with me.Â He could not believe we don’t universally screen everyone for everything possible–yet many patients don’t want any test not 100% needed.Â Others striving so hard to have a baby want to be tested for everything possible.Â As the number of diseases we can test for heads north of 1000 in the next years our ability to test has outpaced policy decisions and protocols of what should be done for the couple who never had a child.Â Â The bigger issue as we enter the future of Obama health care is where does genetic screening for low risk couples for diabling or fatal diseases (the ultimate preventative care) fit into the economic analysis.Â How much is too much?Â I guess it depends on who you ask and who’se paying…

]]>http://docinthemachine.com/economicgenetics/feed/0http://docinthemachine.com/economicgenetics/Breaking News: Vitabiv Antibiotic Associated With Birth Defectshttp://feedproxy.google.com/~r/Docinthemachine/~3/rgEVS9oFNio/
http://docinthemachine.com/vitabiv/#commentsMon, 15 Mar 2010 22:16:57 +0000info@docinthemachine.com (Steven F Palter, MD)http://docinthemachine.com/?p=638<p>I have just received a breaking news update from Astellas regarding risks of using their antibiotic Vitabiv in pregnant women.Â Â This is one of the most strongly worded...</p>
<p>The post <a rel="nofollow" href="http://docinthemachine.com/vitabiv/">Breaking News: Vitabiv Antibiotic Associated With Birth Defects</a> appeared first on <a rel="nofollow" href="http://docinthemachine.com">docinthemachine</a>.</p>I have just received a breaking news update from Astellas regarding risks of using their antibiotic Vitabiv in pregnant women.Â Â This is one of the most strongly worded warnings on use of an antibiotic in pregnancy I have seen recently.Â I received a generic warning update last week from the American College of Ob Gyn that “some warning regarding a drug in pregnancy” was coming today.

As the letter reads:

The purpose of this letter is to inform you of important safety information for VIBATIVâ„¢
(telavancin) for injection, a once-daily intravenous antibiotic indicated for the treatment of adult patients with complicated skin and skin structure infections (cSSSI) caused by susceptible isolates of the following organisms.
An informational program for healthcare providers has been established to help minimize the risks associated with the use of VIBATIV; the most important relates to the use of the product during pregnancy. Animal data indicate that use of VIBATIV during pregnancy is associated with reduced fetal weights and increased rates of digit and limb malformations in offspring, although these malformations were infrequent.
Women of child bearing potential should have a serum pregnancy test prior to administration
of VIBATIV. Patients should be counseled on the risks and benefits of VIBATIV. Consideration
should be given to using an alternative course of therapy, if a positive test result is obtained.
The use of VIBATIV should be avoided during pregnancy unless the potential benefit to the
patient outweighs the risk to the fetus. Women of childbearing potential (those who have not
had: complete absence of menses for at least 24 months or medically confirmed menopause,
medically confirmed primary ovarian failure, a history of hysterectomy, bilateral oophorectomy, or tubal ligation) should use effective contraception during VIBATIV therapy. Patients should be
instructed to notify their prescribing physician/healthcare provider if they become pregnant while taking VIBATIV. A pregnancy registry has been established to collect information about the effects of VIBATIV use during pregnancy. Physicians are encouraged to register pregnant patients, or pregnant women may enroll themselves in the pregnancy registry by calling 1-888-658-4228.